Application of a new polyester patch in arthroscopic massive rotator cuff repair significantly improves clinical outcome and tendon integrity
ESSKA Academy. Smolen D. 05/09/18; 212748; P22-561 Topic: A9 - Head depressing procedures (arthroscopic)
Dr. Daniel Smolen
Dr. Daniel Smolen
Login now to access Regular content available to all registered users.

You can access free regular educational content on the ESSKA Academy by registering as an 'ESSKA Academy User’ here

Access to Premium content is currently a membership benefit.

Click here to join ESSKA or renew your membership.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Objectives: Massive rotator cuff (RC) tears still present a clinically challenging problem and re-ruptures rates are reported in up to 94%. The purpose of this study was to determine the impact of applying a synthetic patch augmentation for the repair of massive RC tears.

Methods: Between 2012 and 2014, 54 arthroscopic RC reconstructions in 54 patients, augmented with a synthetic polyester patch were performed at the Etzel Clinic in Pfaeffikon, Switzerland. Mean patient age at the time of surgery was 65 years (SD±7.8). Preoperative imaging consisted mainly of arthrographic magnetic resonance imaging (aMRI; 52 patients) and arthrographic computed tomography (aCT; 2 patients). Postoperative imaging was more heterogenous due to patients preference and costs, and included mainly ultrasound-examinations followed by aMRI and aCT. Clinical outcome was evaluated using the Constant-Murley Score (CS) as well as the Subjective Shoulder Value (SSV) pre- and postoperatively. Mean follow up was 32 months (9-50 months). Exclusion criteria were severe osteoarthritis, re-ruptures of formerly repaired RC tears and age over 75 years.

Results: The mean CS increased significantly from 37 preoperatively to 82 postoperatively (40-100; p<0.0001), whereas the mean SSV increased from 40 to 89 (45-100; p<0.0001). Furthermore, patients with intact repairs had significantly more strength compared to patients with re-tears (p<0.0001)
We observed nine complete re-ruptures (16.7%) of the patch-augmented RCs in our radiological follow-up in the investigated 54 patients. Furthermore, three partial re-tears were observed radiologically, not showing relation to the excellent clinical outcome and strength in these patients (5,6%). Additionally, re-ruptures did not correlate with revision surgery, which was performed in eight patients. Only one shoulder was re-operated because of a re-tear of the augmented cuff, receiving a delta-flap after patch explantation. Six revisions were performed due to a frozen shoulder or arthrofibrosis with an intact reconstruction and patch. In one patient the patch was removed due to crepitation. No immunological foreign body reactions were found.

Conclusions: The complete re-tear rate was 16.7%. This compared very favorably to non-augmented massive RC-tear repairs in the literature, where re-tear rates are described in up to 94%. Therefore, we conclude that patch augmentation in massive RC tears is a useful technique to reduce re-tears and improve clinical outcome.

Keywords:
Rotator Cuff, Patch Augmentation
Objectives: Massive rotator cuff (RC) tears still present a clinically challenging problem and re-ruptures rates are reported in up to 94%. The purpose of this study was to determine the impact of applying a synthetic patch augmentation for the repair of massive RC tears.

Methods: Between 2012 and 2014, 54 arthroscopic RC reconstructions in 54 patients, augmented with a synthetic polyester patch were performed at the Etzel Clinic in Pfaeffikon, Switzerland. Mean patient age at the time of surgery was 65 years (SD±7.8). Preoperative imaging consisted mainly of arthrographic magnetic resonance imaging (aMRI; 52 patients) and arthrographic computed tomography (aCT; 2 patients). Postoperative imaging was more heterogenous due to patients preference and costs, and included mainly ultrasound-examinations followed by aMRI and aCT. Clinical outcome was evaluated using the Constant-Murley Score (CS) as well as the Subjective Shoulder Value (SSV) pre- and postoperatively. Mean follow up was 32 months (9-50 months). Exclusion criteria were severe osteoarthritis, re-ruptures of formerly repaired RC tears and age over 75 years.

Results: The mean CS increased significantly from 37 preoperatively to 82 postoperatively (40-100; p<0.0001), whereas the mean SSV increased from 40 to 89 (45-100; p<0.0001). Furthermore, patients with intact repairs had significantly more strength compared to patients with re-tears (p<0.0001)
We observed nine complete re-ruptures (16.7%) of the patch-augmented RCs in our radiological follow-up in the investigated 54 patients. Furthermore, three partial re-tears were observed radiologically, not showing relation to the excellent clinical outcome and strength in these patients (5,6%). Additionally, re-ruptures did not correlate with revision surgery, which was performed in eight patients. Only one shoulder was re-operated because of a re-tear of the augmented cuff, receiving a delta-flap after patch explantation. Six revisions were performed due to a frozen shoulder or arthrofibrosis with an intact reconstruction and patch. In one patient the patch was removed due to crepitation. No immunological foreign body reactions were found.

Conclusions: The complete re-tear rate was 16.7%. This compared very favorably to non-augmented massive RC-tear repairs in the literature, where re-tear rates are described in up to 94%. Therefore, we conclude that patch augmentation in massive RC tears is a useful technique to reduce re-tears and improve clinical outcome.

Keywords:
Rotator Cuff, Patch Augmentation
Code of conduct/disclaimer available in General Terms & Conditions

By clicking “Accept Terms & all Cookies” or by continuing to browse, you agree to the storing of third-party cookies on your device to enhance your user experience and agree to the user terms and conditions of this learning management system (LMS).

Cookie Settings
Accept Terms & all Cookies